Provider Demographics
NPI:1447283445
Name:REDHEAD, LIMA LORREN (MD)
Entity type:Individual
Prefix:DR
First Name:LIMA
Middle Name:LORREN
Last Name:REDHEAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26005 RIDGE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:MD
Mailing Address - Zip Code:20872-1899
Mailing Address - Country:US
Mailing Address - Phone:301-414-2305
Mailing Address - Fax:301-414-0476
Practice Address - Street 1:26005 RIDGE RD STE 200
Practice Address - Street 2:
Practice Address - City:DAMASCUS
Practice Address - State:MD
Practice Address - Zip Code:20872-1899
Practice Address - Country:US
Practice Address - Phone:301-414-2305
Practice Address - Fax:301-414-0476
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036110499207V00000X
MDD76568207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD777642000Medicaid
IL036110499Medicaid
IL212568OtherGROUP PIN NUMBER
IL01630253OtherBC AND BS
I06939Medicare UPIN
IL036110499Medicaid